Hypothyroidism
Presented by
Rashmi singh
B.sc nursing 2nd year
General objective
After completion of this teaching practice, students will be
able to gain knowledge regarding Hypothyroidism and they
can utilize the knowledge in clinical setting.
Specific objectives:
At the end of teaching practice students will able to -
● Introduce Hypothyroidism
● Define Hypothyroidism and enlist it's type
● Enlist the causes and Risk factors of Hypothyroidism
● Enumerate the clinical manifestation of Hypothyroidism
● Enlist the diagnostic evaluation of Hypothyroidism
● Explain the management of Hypothyroidism
● Enlist the complications of hypothyroidism
Anatomy and physiology
of thyroid gland
Anatomy and physiology of thyroid gland
● Thyroid gland is a butterfly shaped organ located in the
lower neck , anterior to trachea.
● It consist of two love connected by isthmus.
● Thyroid gland is about 5cm long , 3cm wide and weigh
about 30gm.
● It is highly vascular.
● Thyroid gland produces 3 hormone:
○ Thyroxin
○ Triiodothyronine
○ Calcitonin
Function of thyroid hormone
● The function of thyroid hormone i.e thyroxin and
triiodothyronine is to control the metabolic activity.
● Thyroid hormone is necessary for normal growth.
● Calcitonin is secreted in response to high plasma level to
calcium and it reduces the plasma calcium by increasing its
deposition in bone.
Hypothyroidism
Introduction
● It is a condition in which thyroid gland doesn't produce
enough thyroid hormone.
● Hypothyroidism disturbs the normal balance of chemical
reaction in body and causes many problems such as
obesity, joint pain, heart disease , etc .
Definition
● Hypothyroidism (underactive thyroid) is a condition
characterized by abnormally low thyroid hormone
production.
● It is the most common thyroid disorder.
● Low thyroid hormone level decrease metabolism, and
increase the risk of other health issues.
Epidemiology
● Hypothyroidism occurs most frequently in older women.
● There is an increased incidence of thyroid cancer in men
who have undergone radiation therapy for head and neck
cancer.
● More than 95% of patients with hypothyroidism have
primary or thyroidal hypothyroidism.
Type of hypothyroidism
● Primary hypothyroidism
Insufficient amount of thyroid hormone secreted by thyroid
gland
● Secondary hypothyroidism
It is due to pituitary gland failure ( inadequate amount
secretion of TSH )
● Tertiary hypothyroidism
It is due to hypothalamus failure ( abnormal TRH secretion)
Cause:
● Hashimoto’s thyroiditis
● Radiation therapy
● Iodine deficiency
● Congenital disease
● Pituitary dysfunction
● Thyroidectomy
● Overtreated with anti-thyroid drug
● Pregnancy
● Radioactive iodine
Risk factor
Anyone can develop hypothyroidism, they are at increased risk if
they,
● Are women older than age 60.
● Have an autoimmune disease.
● Have family history of thyroid disease.
● Have been treated with radioactive iodine or anti-thyroid
medication.
● Received radiation therapy.
● Have thyroidectomy.
● Have pregnancy or delivered a baby within the past six months
Clinical manifestation
Clinical manifestation
Other clinical manifestation :
● Poor hearing
● Pleural effusion
● Pericardial effusion
● Poor appetite
● Paresthesias
● Goiter (in some cases)
● Periorbital edema
Diagnostic evaluation
● History collection
● Physical examination
● Subnormal T3 and T4 level
● Elevated serum cholesterol level
Medical management
● Synthetic levothyroxine ( levothyroid or synthroid ) is
preferred.
● Concentrated glucose may be given if hypoglycemia is
evident.
● If myxedema coma is present, thyroid hormone is given
IV until conscious is restored
Dietary management
● If patient having hypothyroidism due to iodine deficiency
then provide high iodine diet.
● Individual with Hypothyroidism must have to avoid eating
highly processed food because they contain a lot of calories,
they may eat low calorie diet because it helps to prevent
weight gain.
● Goitrogens are compound that may interfere with normal
function of thyroid gland so they must be avoided and these
food include cabbage, broccoli, cauliflower, strawberry,
millets, sweet potato, peaches, nuts etc
Nursing management
● Monitor vital sign carefully.
● Administer anti-thyroid drug as prescribed.
● Instruct patient of the need to take medication at the same
time each day and on empty stomach.
● Instruct the patient about importance of continuing
medication after symptoms improved.
● Monitor T3, T4 and TSH level to determine the
effectiveness of pharmacotherapy.
● Monitor patient weight, fluid intake and urine output.
Nursing management
● Nurses should consult a dietitian to ensure a nutritious diet
with adequate calorie and fluid.
● Ensure that if iodine is is the part of the treatment,mix it with
milk , juice or water to prevent gastrointestinal distress.
● Give iodine through straw to prevent tooth discoloration.
● Monitor for decreasing symptoms related to Hypothyroidism
such as cold intolerance, menstrual irregularities, fatigue,
lethargy.
● Promote physical comfort and provide extra clothes and
blankets.
Nursing management
● Advice to avoid high temperature environment and avoid
using heating pads and electric blanket as the risk of
peripheral vasodilation.
Nursing diagnosis
● Activity intolerance related to fatigue.
● Risk of imbalance body temperature.
● Constipation related to depressed gastrointestinal function.
● Ineffective breathing pattern related to depressed
ventilation.
● Deficient knowledge related to thyroid replacement therapy.
Complications
● Birth defect
● Goiter
● Heart problems
● Infertility
● Mental health issues
● Myxedema
Summary
Conclusion
Bibliography
Book reference
● Pee vee - A textbook of Medical surgical nursing,page no.
1357- 1362
● Brunner and suddhart Textbook of medical surgical
nursing, south Asian edition, page no.1256- 1261
Net reference
● https://www.webmd.com
● https://www.mayoclinic.org
● https://www.healthline.com
Thank you!
